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Revitalization has emerged as an innovative treatment approach for immature permanent teeth with necrotic pulp. This article presents a comprehensive analysis of revitalization, focusing on its principles, clinical protocols and outcomes. The article highlights the importance of thorough diagnosis and assessment of the pulp and peri-apical condition to determine the suitability of revitalization. Various factors influencing the success of revitalization, such as the use of scaffolds, growth factors and stem cells, are discussed. Additionally, a case that was treated with a PRP scaffold is also presented. Overall, revitalization shows promise in promoting pulp regeneration and improving treatment outcomes in selected cases of pulp necrosis. CPD/Clinical Relevance: To introduce research-based knowledge to GDPs about the procedure and prognosis of tooth revitalization. [ABSTRACT FROM AUTHOR]

Immature necrotic permanent teeth with a significant amount of coronal hard tissue loss are treated by apexification procedures. These procedures do not encourage further root maturation, predisposing the teeth to possible root fractures. The modified apexification procedure simulates regenerative endodontic procedures in encouraging root development in terms of increased dentine thickness contributing to improved resistance to fracture, while allowing the canal space to be used for core retention. This case report presents an immature tooth treated by the modified apexification procedure with an 18-month follow-up. CPD/Clinical Relevance: An alternative therapy in managing immature necrotic permanent teeth is of relevance to clinicians. [ABSTRACT FROM AUTHOR]

This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia. Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63–3.31]; P <.05) and 48 hours (OR = 2.49; [95% CI, 1.73–3.59]; P <.05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47–3.62]; P <.05) and 48 hours (OR = 2.35; [95% CI, 1.32–4.16]; P <.05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48–4.00]; P <.05). While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted. [ABSTRACT FROM AUTHOR]

A growing body of research supports an association between periapical inflammation and an increased risk of developing systemic diseases. There is currently no scientific evidence to support a causal effect of inflammation on the onset of insulin resistance (IR) in patients with apical periodontitis (AP). The aim of this in vitro study was to evaluate any association between AP and levels of serum inflammatory factors potentially associated with the onset of IR, and to investigate the effect of root canal treatment (RCT) on these systemic inflammation markers and on the response in vitro to insulin. A total of 27 control subjects and 27 patients with AP were enrolled. Patients with AP underwent RCT and were followed-up 6 and 12 months post-treatment. Enzyme-linked immunosorbent assays were used to evaluate serum levels of proinflammatory cytokines interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF)-α. The response in vitro to insulin was assessed by measuring glucose consumption in a human pancreatic epithelioid carcinoma cell line treated with sera from healthy and AP subjects. At baseline AP was associated with significant higher levels of IL-1, IL-6, and IL-8 in the serum of untreated (AP) patients vs controls (P <.001). Glucose consumption decreased in pancreatic cells incubated with baseline serum from patients with AP, in a manner proportional to total cytokines amount. Notably, endodontic treatment was associated with reduced levels of cytokines (P <.001) and improved response to insulin in AP group (P <.001). Our findings suggest that AP may promote inflammatory-driven IR in an in vitro model, and that RCT may ameliorate inflammatory mediators in vivo and the cellular response to insulin in vitro. [ABSTRACT FROM AUTHOR]

The objectives of this article are to report 2 cases of nonsurgical endodontic treatment for the management of periapical lesions associated with large cortical bone perforations and review the literature on the clinical efficacy of nonsurgical endodontic treatment to draw insights from published case reports. Large, cyst-like periapical lesions in 2 patients were successfully treated with combined modalities of root canal treatment, antimicrobial therapy (calcium hydroxide and triple antibiotic paste [TAP]), and mineral trioxide aggregate (MTA) obturation of the canal space. In both cases, instrumentation was extended 1 mm beyond the apical foramen to facilitate drainage through the root canal, because it was assumed that the periapical lesion could be cystic. After instrumentation, TAP was placed within the canal space to aid in disinfection and healing of the dental, pulpal, and periapical conditions. In both patients, the teeth were asymptomatic and functional at follow-up examinations (case 1, 3 years; case 2, 30 months). Supporting the positive outcomes in the 2 clinical cases, the published literature suggests that the use of biocompatible materials such as MTA, which can promote the deposition of hydroxyapatite, has the potential to contribute to tissue regeneration and the healing of large periapical lesions. [ABSTRACT FROM AUTHOR]

Statement of the Problem: During endodontic therapy, irrigation solutions applied in the root canal may affect the physicochemical properties of the dentinal wall, thereby changing its microhardness. This may adversely affect the sealing ability and adhesion of dental materials. Therefore, many studies have focused on the search for an ideal root canal irrigant that has a minimal effect on dentinal microhardness. Purpose: This in vitro study was conducted to determine the changes in dentin microhardness after root canal irrigation with different endodontic irrigants. Materials and Method: Ninety-five freshly extracted maxillary central incisor teeth with straight single canals were selected. These teeth were sectioned transversely at the level of the cementoenamel junction. The working length of each tooth was determined, and canal space was prepared by the HyFlex CM rotary file system. During instrumentation, normal saline was used for irrigation. Then, teeth were split longitudinally into two segments. According to the irrigating solution employed, samples were divided into five groups (n=19): normal saline (Group A), 3% sodium hypochlorite (Group B), 2% chlorhexidine (Group C), 5% calcium hypochlorite (Group D), and 0.2% nanochitosan (Group E).3 mL of the corresponding irrigating solution was administered for total15 minutes in each prepared sample. The Vickers micro-hardness tester was then used to assess micro-hardness. The data was analyzed using one-way analysis of variance (ANOVA). Results: All tested irrigating solutions decreased the dentinal microhardness. Samples irrigated with 5% calcium hypochlorite demonstrated dentinal microhardness of 42.43± 1.62, which is the lowest among all the tested groups, followed by nano chitosan, sodium hypochlorite, and chlorhexidine. Samples treated with control group (saline) demonstrated the maximum microhardness of dentin in the present study. Conclusion: Within the limitations of this research, it can be concluded that the tested novel irrigating solutions, 5% calcium hypochlorite and 0.2% nanochitosan, were more detrimental to radicular dentin microhardness when compared with conventional endodontic irrigants. [ABSTRACT FROM AUTHOR]

Statement of the Problem: It is challenging to perform a pulpectomy procedure in primary tooth because of its physiological root resorption and variation in root morphology. Working length measurement is considered to be one of the critical steps, as it determines the extent of obturation and apical seal. Purpose: To compare the accuracy of electronic apex locator (EAL) and digital radiography (DR) for working length determination in primary teeth. Materials and Method: In this systematic review, electronic databases and grey literature were searched from 1st January 2005 to 1st January 2023 for randomized control trial, nonrandomized control trial, in vitro studies, ex vivo studies that compared accuracy of EAL and DR in primary teeth. Two reviewers independently identified studies, retrieved data, and assessed risk of bias using the revised and validated MINORS (methodological index for non-randomized studies) criteria. Results: Ten studies were included in qualitative analysis. Seven out of ten studies showed low risk of bias whereas other three studies showed high risk of bias. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted. Conclusion: Available evidence suggests a moderate quality of evidence in this systematic review. Analyzing the ten studies included in this systematic review, the majority of studies showed statistically insignificant difference between EAL and DR. However, EAL was closer to actual WL as compared to DR. Based on the evidence that is currently available; EAL can be considered as an alternative for working length measurement in primary teeth. [ABSTRACT FROM AUTHOR]

This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. Surveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. The response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P =.001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P <.001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P <.001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P <.001; regenerative endodontic procedures, P =.002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to investigate the 1-year pulp survival of cracked teeth with reversible pulpitis managed with initial stabilization using orthodontic bands, followed by coronal coverage restorations. One-hundred-and-twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative patient and tooth data were collected. After definitive pulp diagnoses were determined following an interim period of orthodontic banding, coronal coverage restorations were placed. Cox and logistic regression analyses were used to assess possible prognostic factors and to correlate initial time to pulp stabilization while in orthodontic bands with eventual outcome. Pulp survival was determined using both clinical and radiographic findings. One-hundred-and-six cracked teeth were followed up at 1 year. Pulp survival based on clinical and radiographic findings was found in 81 teeth (76.4%). Out of 25 failures, 11 (44%) required root canal treatment (RCT) in the orthodontic band stage and 10 (40%) required RCT during the process of or after coronal coverage restorations. Four teeth (16%) had incidental findings of periapical radiolucencies at the 1-year review without clinical symptoms. Teeth requiring RCT were found to have required longer periods in orthodontic bands prior to a definitive pulp diagnosis (P <.05). A step-by-step approach by using orthodontic banding to monitor pulp status may reduce the incidence of RCT required through definitive coronal coverage restorations for cracked teeth with reversible pulpitis. [ABSTRACT FROM AUTHOR]

Often there is the need of moving endodontically treated teeth. Orthodontic movement may have no effect on the prognosis of teeth with root canal treatment (RCT). To verify this subject, we evaluated the effect of orthodontic movement on the prognosis of RCT teeth using cone-beam computed tomography (CBCT) and further explored the influence of orthodontic movement on the prognosis of RCT teeth with and without apical periodontitis (AP). This retrospective study was conducted by evaluating 169 RCT teeth of 100 patients who had undergone fixed orthodontic treatment. AP was assessed and classified using the CBCT periapical index. Univariate analysis of RCT outcome was performed for the total RCT group, RCT without AP group and RCT with AP group. Multivariate logistic regression was performed for the total RCT group and RCT without AP group, respectively, but not for the RCT with AP group. Variables related to the prognosis of RCT were included, such as age, gender, tooth position, RCT quality, coronal restoration quality, periodontal condition, orthodontic traction distance, and orthodontic rotation angle. The orthodontic traction distance and rotation angle were not significantly correlated to the RCT outcomes, regardless of the presence of AP. Among the total RCT group, teeth with unqualified RCT (odds ratio = 3.42, P =.004) and inadequate coronal restoration (odds ratio = 4.40, P =.031) had a lower success rate. Of the 97 RCT teeth without AP, unqualified RCT was a risk factor for treatment failure (odds ratio = 3.55, P =.041). Of the 72 RCT teeth with AP, the univariate analysis showed that RCT quality were significantly related to the outcome (P =.042). Orthodontic movement had no effect on the prognosis of RCT teeth regardless of the presence of AP. [ABSTRACT FROM AUTHOR]

Untreated canals are a primary cause of persistent apical periodontitis, and the inability to identify and adequately treat canals has been considered a major cause of failure of root canal therapy in maxillary molars. The purpose of this retrospective study was to use cone beam computed tomography (CBCT) to quantify the number of missed canals in maxillary first and second molars needing endodontic retreatment after treatment by general dentists. A total of 401 CBCT scans of maxillary first and second molars were examined. A total of 214 scan sets (53.37% [95% Cl, 48.48%-58.25%]) showed evidence of an untreated canal, with the highest rate (49.38%; n = 198) observed in the second mesiobuccal canal. Imaging revealed that multiple canals were missed in some patients, for a total of 225 missed canals. The examinations showed untreated first mesiobuccal canals in 2.99% of CBCT scan sets (n = 12), untreated distobuccal canals in 2.99% of CBCT scan sets (n = 12), and untreated palatal canals in 0.75% of CBCT scan sets (n = 3). Preoperative CBCT imaging should be considered prior to initial root canal treatment of maxillary molars. When the risks and limitations of CBCT are taken into consideration, the additional information it provides can improve diagnostic accuracy, increase confidence in decision-making, and positively impact treatment planning. [ABSTRACT FROM AUTHOR]

Artificial teeth in dental training have become a valuable tool for students to gain hands-on experience in a safe and controlled environment. This training method allows students to practice various dental procedures and develop their skills without putting patients at risk. Artificial teeth can be used to simulate dental conditions, allowing students to gain experience in dealing with various situations and techniques. Although previous studies in human dentistry have demonstrated the feasibility of using 3D-printed teeth for teaching endodontic procedures such as root canal therapy, similar research has yet to be conducted in the veterinary field. This study aimed to assess the feasibility of creating 3D-printed teeth from an adult dog skull and validate their use as an alternative training tool for root canal therapy in this species. For this, cone beam computed tomography images from a medium-sized dog skull were used to replicate its teeth using a digital 3D printing system. Then, artificial mandibular first molar teeth and a 24-question survey were sent to specialized veterinary dentistry practitioners in Brazil to assess their perception of the model's characteristics during endodontic treatment. In conclusion, it was feasible to create 3D-printed models of dog teeth with high accuracy for the endodontic system. Despite the differences in the properties of the two materials between natural and artificial teeth, it was possible to use the artificial tooth as a training device for conventional endodontic treatment in dogs. The reliability level for the survey was reported as good, displaying a reliability coefficient above 0.86. [ABSTRACT FROM AUTHOR]

Endodontically treated teeth are more prone to vertical root fracture with the mechanical property changes to some extent during root canal treatment. This study aimed to investigate the effects of a bioceramic sealer on the mechanical properties of tooth roots. Dentin discs were dried by two different methods (ethanol drying and paper points drying) and then filled with a BC sealer named iRoot SP. SEM and EDS were used to analyze the newly formed minerals in dentin tubules. Elastic modulus and hardness of the secondary dentin in areas proximal to the primary dentin (PD-SD) and areas proximal to canal or iRoot SP (SD-C/SD-iRoot SP) were measured using nanoindentation technique. The compressive strength of roots filled with iRoot SP were tested by compressive loading test. (1) Penetration and mineralization: Paper points drying was more conducive to iRoot SP adhesion, spreading and penetration into the dentin tubules than 95% ethanol drying. (2) Micromechanical properties: After filling root canal with iRoot SP, the elastic modulus and hardness of SD-iRoot SP were higher than those of PD-SD (P = 0.001 and P = 0.000). (3) Fracture resistance: The compressive strength of the roots filled with iRoot SP was not significantly different from that of the roots unprepared and unfilled (P = 0.957), but was higher than that of the roots prepared and unfilled (P = 0.009). Excessive drying (95% ethanol drying method) is not conducive to the penetration and mineralization of the BC sealer iRoot SP into dentin tubules. The good bioactivity of iRoot SP was responsible for increasing the elastic modulus and hardness of dentin, which strengthened the prepared roots. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Successful endodontic treatment depends on three-dimensional (3D) root canal filling to prevent the leakage of residual bacteria. Different obturation techniques with different sealers should be compared by employing advanced assessment tools. Purpose: This study compared the obturation quality of warm vertical compaction (WVC) and two different single-cone (SC) techniques using micro-computed tomography (micro-CT). Materials and Method: Thirty-three extracted maxillary molars with mesial root canal curvature of 20‒40º were prepared in vitro with One-Curve files and randomly assigned to three groups (n=11) for root canal obturation with WVC, SC technique with AH Plus sealer (SC-AH), or SC technique with SureSeal bioceramic (BC) sealer (SC-Su). The root canals underwent micro-CT examinations before and after obturation to determine the volume percentages (VPs) of voids and gaps at different distances from the apex (coronal, middle, and apical thirds). Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: The highest VP of voids and gaps was recorded in the SC-Su group, with no significant difference from other groups (p> 0.05). There were significant differences in VP of gaps at different distances from the apex (p<0.05). The VPs of gaps in the apical third of all the samples were significantly higher than in the coronal and middle thirds. However, the difference in VP of voids was not significant at different distances from the apex (p>0.05). Conclusion: None of the tested techniques could provide a void-free and gap-free filling. The apical third of the canals showed the highest VP of gaps in all obturation techniques. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Treatment of immature necrotic teeth is a problematic situation. Conventional root canal therapy is challenging and leaves a weak, fragile, and undeveloped tooth for lifetime. Purpose: This review was aimed to assess the outcome of available randomized clinical trials (RCTs) on the efficacy of platelet concentrates (PC) in dentine-pulp complex regeneration. Materials and Method: In this systematic review, an electronic search was conducted on MEDLINE, EMBASE, Cochrane, and Google scholar databases. A further manual search was performed on the list of related articles in order to ensure inclusion of potentially missed articles in earlier electronic search. Those proved RCTs matched with the standard criteria were included following an initial assessment of abstracts and the text independently by the reviewers. Results: From the total 602 harvested articles, only 13 met the criteria and were evaluated with 11 having parallel design and 2 split mouth. Only one study featured low risk of bias, while three had moderate risk and the rest were at high risk of bias. Six studies had used platelet rich plasma (PRP), 4 employed platelet rich fibrin (PRF), one utilized injectable platelet rich fibrin (I-PRF), and three used both PRF and PRP for their experimental groups while blood clot (BC) was used as the control group for all. The success rate was reported at 87.3% judged by the absence of pathologic signs and symptoms. Conclusion: Dentin wall thickening, root lengthening and apex closure were higher in PC groups, however, these differences were not statistically significant in reported studies. It can be concluded that PCs promote the pulp tissue revitalization and continuation of root development. However, a consensus on its potency for true pulp regeneration is yet to be reached. [ABSTRACT FROM AUTHOR]

An in-depth understanding of the anatomical variations of maxillary molars is essential for endodontic success. Unlike the maxillary second molars, the presence of a second palatal root is uncommon in the first maxillary molar. This case report describes two cases of non-surgical management of maxillary molars with extra palatal roots. Careful clinical examination, knowledge of the internal anatomy, and the use of advanced radiographic modalities like cone beam computed tomography (CBCT) can reveal the presence of variations in the internal and external anatomy of any tooth. Therefore, for nonsurgical as well as surgical management clinicians should always watch out for any deviations in a tooth and utilize all the available tools to diagnose and manage them successfully. [ABSTRACT FROM AUTHOR]

The adoption ofvital pulp therapy (VPT) is a significant advancement in preserving the longevity of vital mature pulp. VPT represents a potential alternative approach to nonsurgical root canal therapy in which compromised pulp is treated such that it maintains its vitality and fimetion. With the introduction of novel bioceramic niaterials, including calcium silicate cements mid mineral trioxide aggregate. the prognosis for VPT in mature permanent teeth has greatly increased. and asa result. adaptation of VPT in these teeth has garnered considerable support. This article reviews evidence-based guidance for case selection and procedural methods associated with the adoption of VPT in mature permanent teeth. [ABSTRACT FROM AUTHOR]

A comprehensive understanding of the factors that influence treatment outcomes is crucial in endodontic diagnosis and treatment planning. Having knowledge that takes into account dental and patient related conditions when choosing procedures can help clinicians maximize the prognosis of natural teeth and reduce postoperalive complications. That being said, tlie landscape of outcome studies in endodontics is continually evolving, presenting a challenge for many clinicians trying to stay current with the latest literature. This article reviews factors that influence the outcomes of the following endodontic therapies: primary root canal treatment, nonsurgical retreatment, and surgical retreatinent. An emphasis is placed on the importance of considering preoperative and treatment-related factors as prognostic indicators before developing a treatment plan, with the ultimate goal of enhancing tooth durability and ensuring patient satisfaction. [ABSTRACT FROM AUTHOR]

The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10–11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction. Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10–11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis. In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P <.001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10–11 years. The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years. [ABSTRACT FROM AUTHOR]

Large-scale clinical studies on the incidence of middle mesial canals (MMCs) in nonsurgical root canal treatment (RCT) and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received RCT or nonsurgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs. Included were 3018 mandibular molars that received RCT (n = 1624) or NSRetx (n = 1394) by 3 endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed. Incidence of MMCs was 8.8% (n = 267). Although the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (P =.07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (risk ratio [RR] = 1.62; 95% confidence interval [CI], 1.28–2.06), male gender (RR = 1.48; 95% CI, 1.18–1.85), preoperative cone-beam computed tomography (CBCT) (RR = 1.48; 95% CI, 1.17–1.89), and first molar (RR = 2.30; 95% CI:1.74–3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR = 2.26; 95% CI, 1.55–3.30) but not in the NSRetx group (RR = 1.11; 95% CI, 0.82, 1.50); and with preoperative CBCT only in the NSRetx group (RR = 1.78; 95% CI, 1.28, 2.50) but not in the RCT group (RR = 1.10; 95% CI, 0.71, 1.69). Associations with younger age and first molar remained unchanged. Overall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment. [ABSTRACT FROM AUTHOR]

This report outlines 2 digitally planned cases in which the teeth underwent magnetic extrusion to preserve the supracrestal tissue attachment and regain the ferrule, followed by their restoration. Case 1: A 42-year-old man with the chief concern of a fractured right maxillary second premolar. Following the completion of root canal treatment, the remaining tooth structure was insufficient to create a ferrule for tooth restoration. For this scenario, a rapid magnetic extrusion technique was performed on tooth #4 to obtain an approximate 3-mm ferrule. The condition of both the dentition and the restorative margin was acceptable 18 months following treatment. Case 2: A 62-year-old man with the chief complaint of mobility on both sides of the maxillary arch in relation to a tooth-supported fixed partial denture (FPD). Following removal of the FPD, multiple extractions were carried out and tooth #6 was subjected to magnetic extrusion in 3 stages to a maximum of 4 mm to obtain a ferrule. At the 18-month and 3-year follow-up appointments, the tooth had no symptoms and the gingiva around the restorations had optimal architecture and margins. The 3-dimensional digital planning was helpful in precisely positioning the magnets within the tooth and the provisional restorations to facilitate axial extrusion. The extruded teeth were restored with zirconia crowns in both cases. The beneficial outcomes observed from these cases provides evidence that the integration of digital planning and magnetic extrusion holds promise as a method for reconstructing teeth with crowns that are significantly compromised. [ABSTRACT FROM AUTHOR]

This clinical recommendation introduces a practical approach for the removal of gutta percha remnants near open apices in root canal retreatment using orange oil. This advice discusses the rationale for the technique, provides a step-by-step description, and outlines its advantages and limitations. This minimally invasive cost-effective approach offers dental practitioners greater effectiveness and safety in addressing the challenge of gutta percha removal near open apices. CPD/Clinical Relevance: A minimally invasive cost-effective approach that offers effectiveness and safety when removing gutta percha near open apices is described. [ABSTRACT FROM AUTHOR]

Background and objectives: Patient education and health literacy are crucial in dentistry, prior to complex procedures like root canal treatment (RCT), that are often associated with anxiety. This mixed-methods pilot study explored the effectiveness of educational material on patients' understanding and experiences of RCT, and dentists' feedback on using a new resource. Methods: Before RCT, patients were provided with an existing New Zealand Dental Association (NZDA) education pamphlet or an enhanced educational resource (EER) in pamphlet or online format, and surveys were conducted to evaluate their helpfulness. Dentists were interviewed to gather insights on the use and value of the resources. Quantitative data and variable relationships were compared using Chi square tests and qualitative data was thematically analysed. Results: The patients valued their dentist as an 'educator' but appreciated the clarity, simple language and visual aids in the resources, which answered questions, enhanced understanding, and reduced anxiety. Those who had received the EER (pamphlet and online) better understood the stages of RCT, reported significantly lower levels of anxiety after RCT (p=.04) and had positive overall experiences. The EER improved and supported dentists in consent processes and enhanced patient-dentist communication. Conclusions: The findings from this study highlight the value of providing patients supplementary educational material to enhance their health literacy and experience of RCT. Dentists have an important role in educating their patients and clear and informative resources are valuable adjuncts. Further validation of these findings in broader clinical settings is warranted. [ABSTRACT FROM AUTHOR]

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The objective of this case study is to report on the diagnosis and treatment of medication-related osteonecrosis of the jaw (MRONJ), which was originally misdiagnosed and mistreated as endodontic disease. A patient was referred for worsening odontalgia despite root canal therapy on tooth No. 19 and a course of oral antibiotics. Examination demonstrated slight buccal swelling and tenderness in the left masseter and a 7-mm diameter area of exposed bone on the mandibular left lingual torus. Further history-taking revealed prior bisphosphonate therapy for metastatic breast cancer. MRONJ was identified as the likely diagnosis, and the patient was appropriately referred to oral and maxillofacial surgery where the diagnosis was confirmed and surgical debridement performed. The case study demonstrates how the symptomatology and presentation of MRONJ can resemble endodontic disease and that timely and appropriate treatment requires eliciting an in-depth medical history, reaching a complete pulpal and periapical diagnosis, and remaining attentive to the presence of exposed bone on examination. [ABSTRACT FROM AUTHOR]

This study investigated the wettability and consistency of various endodontic sealers, both inorganic and organic, and evaluated their sealing ability of root canals using the single-cone obturation technique, with and without ethylenediaminetetraacetic acid (EDTA) treatment. Bovine root canals were endodontically prepared and filled in preparation for the dye penetration test with toluidine blue solution. All sealers exhibited contact angles similar to or lower than dentin and displayed superior consistency. Among the sealers, organic sealers used without EDTA treatment showed reduced dye penetration compared to inorganic sealers. However, some inorganic and organic sealers showed dye penetration in the sealer and dentin of root canals subjected to EDTA treatment. In conclusion, the single-cone obturation technique, combined with these endodontic sealers, achieved close contact with root canal dentin due to their wettability and consistency. However, the sealing ability of certain sealers was influenced by EDTA treatment. [ABSTRACT FROM AUTHOR]

Nicolau syndrome (NS) is a rare complication resulting from intramuscular injections. It is characterized by severe pain at the injection site and the development of purplish discoloration. Only a limited number of case reports have been published documenting the adverse effects associated with the injection of calcium hydroxide (CH) beyond the apex during endodontic treatment. Here, we present the case of a 16-year-old female with NS after the injection of CH during the root canal treatment. The radiography examination revealed distal occlusion of the right maxillary and facial arteries. This caused a substantial area of skin necrosis to develop on the patient's face, resulting in permanent scarring. NS is associated with the displacement of CH beyond the apex. To minimize the risk of NS, dentists should exercise caution by avoiding forced injection of CH during treatment, particularly when the root canal is actively bleeding. [ABSTRACT FROM AUTHOR]

This report shows atypical sealer extrusion of permanent mandibular left first molar (tooth #19) after nonsurgical root canal treatment which is mimicking root perforation or root resorption. The chief complain was slight discomfort with round opening next to the tooth. Depends on the clinical and radiographical finding, tooth #19 was diagnosed as necrotic pulp with chronic apical abscess. Nonsurgical root canal treatment was provided using ProTaper gold (Dentsply Tulsa Dental, Tulsa, OK, USA) to size F3. 4 canals were located (2 mesial canals and 2 Distal canals). The tooth was obturated with single cone and Calcium Silicate-based Bioceramic Root Canal Sealer (CeraSeal). The sealer was extruded which looks like root perforation or root resorption. Finally, the tooth was crowned with single crown The patient had no symptoms, no periodontal pocket, no mobility after 3 years. The sealer can extrude not only in the apical area but also it may fill and follow the trac of sinus tract. However, it doesn’t affect the success rate of root canal treatment with proper cleaning and shaping, 3-dimentional obturation, and a good crown. [ABSTRACT FROM AUTHOR]

Endodontic treatment is the primary method for treating complicated caries, specifically pulpitis and periodontitis. Antiseptic irrigation solutions can minimize the number of bacteria and improve the long-term prognosis and survival rate of endodontic therapy. Polyhexanide shows promise as antiseptic irrigant for root canal treatment due to its good antimicrobial properties and substantivity. The aim of this study was to assess the viability of free gingival multipotent mesenchymal stromal cells (MMSCs) when exposed to varying concentrations of polyhexanide hydrochloride and chlorhexidine bigluconate, and to compare the resulting outcomes. Based on the analyzed data, 0.1% and 0.2% polyhexanide-based solutions were found to be less cytotoxic and resulted in lower cell viability affection compared to the 2% aqueous chlorhexidine solution commonly used in endodontics. [ABSTRACT FROM AUTHOR]

PurpOse: To compare the fracture resistance and failure mode of porcelain laminate veneers with different preparation depths in endodontically treated teeth. Methods: Root canal treatment was performed for 40 maxillary central incisors, and then the teeth were divided into four groups (n= 10). The preparation depths were as follows: Group A: 0.9 mm, Group B. 0.6 mm, Group C: 0.3 mm, and in all three groups, 2 mm butt joint incisal reductions were performed; Group D was a control group with no preparation. Then 30 lithium disilicate porcelain veneers were milled by CAD-CAM method and cemented. After that, all specimens were subjected to cyclic loading and thermal cycling and finally were tested by a universal testing machine until failure occurred. Results: The mean failure loads (N) after exposure to continuous load were as follows: Group A: 625.70 (401.45-1037.77), Group B: 780.32 (222.93-1391.82), Group C: 748.81 (239.68-1241.87) and Group D (control): 509.88 (84.42-1025.85) and P= 0.216. Analysis of failure mode in four groups showed that P= 0.469. There was no significant difference between the control and the other groups. In this study, 0.3,0.6 and 0.9 mm depths of preparation for porcelain laminate veneers for endodontically treated teeth had no significant difference in fracture resistance and failure mode with non - prepared teeth. [ABSTRACT FROM AUTHOR]

This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. IFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P <.05), and IL-2 and TGF-β (P <.05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P <.05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P <.05). IFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment. [ABSTRACT FROM AUTHOR]

This study aimed to assess the influence of different coronal flaring files on dentin removal in mandibular teeth using cone-beam computed tomographic (CBCT) images. CBCT images of 48 mandibular molar teeth were acquired and randomly divided into 2 main groups, with each main group further divided into 3 subgroups. In the first main group, root canal preparation was performed using TruNatomy (Dentsply Sirona, Ballaigues, Switzerland), ProTaper Gold (Dentsply Sirona), and One Curve (Micro-Mega, Besancon, France) files without the use of coronal flaring files. In the second main group, root canal preparation was performed using the same files with the use of coronal flaring files. After the completion of root canal preparation, a second set of CBCT images was obtained. Subsequently, the dentin removal and remaining critical dentin were assessed by measuring at 4 distinct points below the furcation level. Data were compared between groups using the Mann-Whitney U and Kruskal-Wallis tests with alpha set at 5%. The ProTaper Gold files demonstrated higher dentin removal compared with the TruNatomy files. In the no-flaring groups, the One Curve files exhibited greater dentin removal than the TruNatomy files at specific levels. The use of coronal flaring files generally did not significantly impact dentin removal, except for certain cases in the TruNatomy and ProTaper Gold groups. The TruNatomy instrument group was more effective in preserving pericervical dentin compared with the other instrument groups. Coronal flaring files can be confidently used to preserve critical dentin during root canal treatment. [ABSTRACT FROM AUTHOR]

Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis. For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding. The success of a pulpotomy depends on the clinician's experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions. [ABSTRACT FROM AUTHOR]

At its core, endodontics is a specialty centered on saving patients' teeth. Nonsurgical root canal therapy and nonsurgical retreatment, arguably the "bread and butter" of endodontics, not only facilitate the preservation of the natural dentition, but in many cases, alleviate pain. Most patients arrive for endodontic treatment expecting symptom relief. A small percentage of these patients, however, experience just the opposite. Within 48 to 72 hours, these select patients experience worsening symptoms, including swelling and pain, and may wonder what mishaps may have occurred during their treatment. These symptom exacerbations are referred to as endodontic flare-ups and are well-documented in the literature. In most cases their occurrence does not reflect a lack of practitioner judgment or skill, but rather a biologic event resulting from a shift in the delicate balance of the bacterial communities and inflammatory events at the periapex. This article reviews the pathophysiology and treatment of endodontic flare-ups, thereby informing patient communication strategies surrounding these events, to preserve both the teeth in question as well as patient relationships. [ABSTRACT FROM AUTHOR]

A number of sealers with different chemistries are badged as Bioceramic, implying biological activity, but have dissimilar properties, which has implications on the sealer properties and will affect the quality and outcome of root canal treatment. This study aimed to assess the physical and chemical properties of 3 hydraulic cement–based sealers, namely BC Universal sealer compared with Totalfill BC sealer and AH Plus Bioceramic. The microstructure and composition of the sealers were assessed using scanning electron microscopy and energy dispersive spectroscopy after setting. The crystalline phases were assessed by X-ray diffraction analysis and the leachates were tested using inductively coupled plasma. All testing was performed at 0, 7, and 28 days. The physical properties of film thickness, flow, radiopacity, and solubility were evaluated using ISO 6876:2012 standards. All 3 sealers contained calcium, zirconium, and silicon. Totalfill BC had the highest calcium release at 7 and 28 days followed by AH Plus Bioceramic and BC Universal sealer. All 3 sealers adhered to the ISO standard in terms of flow and radiopacity. BC Universal sealer was slightly over the range (>50 μm) for film thickness. All sealers exceeded the solubility range set by ISO 6876:2012. Although these hydraulic cement sealers had similar components and delivery, the properties varied significantly. The testing of material properties to confirm the suitability for clinical use is necessary. [ABSTRACT FROM AUTHOR]

Apical lesions of endodontic origin can be classified as either granulomas or cysts. In rare cases, respiratory epithelium can proliferate and encapsulate a lesion, forming a cyst. Moreover, the innervation of apical lesions has only been previously reported in animal models of apical periodontitis. This report demonstrates an unusual case in which tooth #15 was initially treated with nonsurgical root canal therapy. Still, the patient remained in moderate to severe pain for several days following the procedure. Next, an intentional replantation was performed in which a periapical cyst was curetted from the alveolus. The patient experienced immediate pain relief following the procedure. Histological analysis revealed that the periapical cyst was lined entirely with respiratory epithelium, and immunohistochemical analysis showed it to be densely innervated. In addition, these nerve fibers expressed the LPS receptor, TLR4. This is the first demonstration of the innervation pattern of a periapical cyst. Further studies are warranted to evaluate innervation in apical lesions and its correlation with pre- and intra-operative symptoms and their participation in the pathogenesis of apical periodontitis. [ABSTRACT FROM AUTHOR]

This study investigated endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry. The primary objective of this study was to determine the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants. The secondary objective was to evaluate the proportion of these teeth that, according to experienced endodontists, could have been preserved. The UNC-Chapel Hill's dental electronic health records between 2004 and 2019 were probed for implant placement that replaced root canal–treated teeth. Preextraction radiographs and clinical charts were examined to ascertain the primary reason related to the extraction and to compile a profile for each case. In cases in which endodontic failure was the primary reason for extraction, radiographs and clinical findings were evaluated by 2experienced endodontists to assess potential treatment options. Between 2004 and 2019, 29.3% (1564 of 5229) of teeth replaced by dental implants at UNC School of Dentistry had undergone root canal treatment, with the mandibular first molar being the most commonly replaced tooth. The leading reasons for extraction were recurrent caries associated with defective restoration (26.6%), fracture of coronal structure (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Two experienced endodontists evaluated extractions due to endodontic failure and concluded that 61.7% of them could have been candidates for endodontic retreatment. Substantial loss of tooth structure was the leading cause of extraction of root canal–treated teeth, followed by vertical root fracture and periodontal disease. Although endodontic failure constituted a minor portion of the reasons for extraction, a considerable number of teeth were extracted due to vertical root fractures following root canal treatment. A significant proportion of the extracted teeth due to endodontic failure could have been considered as potential candidates for endodontic retreatment. [ABSTRACT FROM AUTHOR]

The purpose of this in vitro study was to investigate the apical and coronal loads generated during shaping canals with 2 successive reciprocating files in comparison to a single reciprocating file from the same system. A total of 40 narrow and straight canals were distributed into two groups: R-Motion with single file (RMS) and R-Motion with multiple files (RMM). In both groups, the R-Motion system was used in a reciprocating motion. After establishing glide path, the RMS canals were shaped down to working length with a single file (25/.06) in two insertions while the RMM canals were shaped with two files (20/.04 and 25/.06) to the working length. The shaping time and effects of tested groups on the apical and coronal peak loads were statistically analyzed using the t -test and Mann-Whitney U test, respectively, at a 95% confidence level. All canals were completely shaped in three insertions and no file deformation or fracture was observed. The RMS and RMM were able to shape canals in 117.3 ± 15.1 and 123.7 ± 7.3 seconds, respectively (P <.05). Within each group, the shaping load appeared to increase with the successive insertions of the file. In both groups, the ranges of apical and coronal peak loads were 0.41–1.87 N and 0.38–1.03 N, respectively. The RMM and RMS had comparable apical and coronal peak loads (P >.05) except in the last insertion where RMM showed clearly lower apical peak load than RMS (P <.01). Under the current laboratory conditions using the R-Motion system, preshaping the canal with a smaller reciprocating file was shown to favorably reduce the apical peak loads induced during canal shaping of extracted teeth. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to assess the existing literature and examine whether or not the size of apical enlargement during mechanical preparation affects the outcome of treatment in patients undergoing nonsurgical root canal therapy (NSRCT). MEDLINE (PubMed), Embase, Cochrane Library, and gray literature were searched (January 2000–May 2023). Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for risk of bias and quality of evidence and were meta-analyzed to estimate the treatment effects. Two studies were included in the meta-analysis. The overall pooled success rate was 75.8%. The success rates of treatment with an apical size ≥ 30 and < 30 were 80.9% and 52.9%, respectively. Cases with an apical size ≥ 30 demonstrated significantly more favorable results (RR = 0.63, 95% Confidence Interval 0.46–0.79, P <.05). The overall quality of evidence was low. With a low certainty of evidence, master apical preparation size ≥ 30 may result in an increased healing outcome in terms of clinical and radiographic evaluations. [ABSTRACT FROM AUTHOR]

Dentists spend a long time the day in the position. It is possible that this leads to discomfort that may translate to procedural errors during treatment, such as root canal treatment. This study aims to investigate the relationship of working posture and procedural errors in endodontic manipulations. 32 dentists (17 men, 53.13%, and 15 women, 46.88%) from the University Dental Polyclinic of Uzhhorod National University (Uzhhorod, Ukraine) were included in the study. REBA, RULA, frequency of procedural errors were analysed using regression. This study revealed a surprising trend where a decrease in errors during endodontic treatment was associated with higher RULA and REBA scores, contrary to the expected increase in errors with higher ergonomic stress. Additionally, the research highlighted the significant impact of a dentist's handedness and tooth position in the dental arch on treatment ergonomics and efficiency, as observed and analyzed through ergonomic assessments and statistical methods. The study conclusively demonstrated that optimal positioning and alignment during dental procedures significantly contribute to a reduction in procedural errors, underscoring the importance of ergonomics in clinical dentistry. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges and limitations of current diagnostic methods in endodontics, highlighting the need for more accurate and reliable techniques to assess the condition of the dental pulp. Topics discussed include the classification of pulpal disease, shortcomings of sensibility tests, advancements in vitality testing methods, and future trends in pulpal diagnostic technology.

This case report describes the treatment of two maxillary central incisors following a traumatic injury with tooth #8 developing replacement resorption and #9 developing inflammatory root resorption. A 10-year-old girl presented complaining of pain in her maxillary central incisors. Upon clinical examination, teeth #8 and #9 were tender to percussion and palpation of the buccal soft tissues. Thermal and electrical pulpal sensitivity tests for teeth #8 and #9 were negative. An intraoral periapical radiograph revealed resorptive defects in tooth #8, which were filled with bone-like tissue, while tooth #9 had radiolucent resorptive defects along the root surface and a periapical radiolucency. A diagnosis of replacement resorption was made for tooth #8 and external inflammatory root resorption for tooth #9. Tooth #8 was treated with a multidisciplinary approach utilizing a guided template for premolar autotransplantation with an immediate veneer restoration, while tooth #9 was managed with root canal treatment using a tricalcium silicate cement to fill the canal. At the 1, 4, 8, 12, and 24-month follow-ups, the patient remained asymptomatic, and there was no radiographic evidence of root or periapical pathosis on either tooth. The root-end of the donor tooth transplanted to the #8 site continued to develop. This case report highlights successful interdisciplinary management of two forms of root resorption using modern treatment strategies that provided immediate function and esthetics to the maxillary central incisors in a young patient following trauma. [ABSTRACT FROM AUTHOR]

This study used a correlative multianalytical approach to investigate the bacteriologic conditions in the apical root canal system of treated teeth with or without apical periodontitis and their correlation with the technical quality of the previous root canal obturation and the presence and volume of apical periodontitis lesions. Root apexes were obtained from recently extracted root canal–treated teeth with (n = 23) and without (n = 22) apical periodontitis lesions as demonstrated by cone-beam computed tomographic examination. The root apexes were sectioned and subjected to micro–computed tomographic (micro-CT) scanning. The specimens were cryopulverized, and DNA extracted from the powder was used as a template in real-time polymerase chain reaction assays to quantify total bacteria and members of the Streptococcus genus and Actinobacteria phylum. The bacteriologic findings were compared between the 2 groups and also evaluated for associations with cone-beam computed tomographic and micro–computed tomographic data. Bacteria were detected in all apical canal samples except 1. The mean counts of total bacteria, streptococci, and actinobacteria did not differ significantly between teeth with or without apical periodontitis (P >.05). Streptococcus levels were significantly lower by 80% in the apical canals of teeth with small lesions compared with those without lesions (P <.05). The limit of filling >2 mm short was significantly associated with more total bacterial counts compared with canals filled 0–2 mm short (P <.05). An adequate coronal restoration was significantly associated with lesser counts of Streptococcus (P <.05). Comparable bacterial loads were observed in the apical canal system of treated teeth with and without apical periodontitis, suggesting that factors other than only the total bacterial levels may also influence the development and progression of apical periodontitis. Bacteria were found in the apical canal in virtually all cases with a high prevalence of streptococci and actinobacteria. Streptococci counts were significantly higher in the apical canal of teeth with inadequate restorations and teeth with no lesions. Underfilled canals showed higher bacterial counts. [ABSTRACT FROM AUTHOR]

When considering performing root canal re-treatment, we must first consider why the original treatment failed. Failure of root canal treatments can occur when ideal technical standards for control of the root canal infection are not achieved. Sometimes, extraradicular infection may prevent a successful treatment outcome. Teeth with post-treatment peri-apical infection can be managed by either non-surgical or surgical root canal re-treatment, both of which aim to restore health to the peri-apical tissues and prolong the survival of the tooth in the oral cavity. [ABSTRACT FROM AUTHOR]

Dental anxiety is a prevalent concern among individuals undergoing root canal therapy. This study aims to assess the levels of dental anxiety among Jordanian patients undergoing root canal treatment. A total of eighty-two adult patients who underwent nonsurgical root canal therapy at the School of Dentistry, University of Jordan, participated in this study. Pre- and post-treatment questionnaires were administered to assess anxiety levels, age, and gender. Post-treatment questions solicited participants' ratings of anxiety levels and perceptions of certain aspects of the endodontic treatment experience. Analysis revealed that 43.9% of participants reported a reduction in anxiety levels following root canal therapy. Furthermore, a significant majority (96.3%) expressed willingness to undergo root canal treatment again to preserve their teeth. Technological advancements in materials, instruments, microscopes, and other innovations have contributed to decreased patient anxiety levels during root canal procedures. [ABSTRACT FROM AUTHOR]

This case report is for a rare case of root canal treatment of the permanent maxillary right first premolar presented with three roots and three canals (Vertucci Type VIII). The patient is a 67-yearold male with hypertension and is allergic to milk and hydrocodone. The affected tooth was diagnosed with necrotic pulp with symptomatic apical periodontitis during examination. Root canal treatment was carried out in this patient under rubber dam isolation, and cleaning and shaping were done with the help of ProTaper Gold rotary files. The obturation was done using a continuous wave compaction technique by the Calamus Dual Obturation System. The unusual anatomy of this case can occur in only 0.95-1.6% of cases. The difficulty in treating such cases is identifying the extra canal. Cone Beam Computed Tomography is the gold standard in finding such a canal. However, in this case, two periapical radiographs were taken to identify the extra root due to the absence of CBCT in the clinic. Using Cone Beam Computed Tomography, periapical radiographs with different angulations and magnification enhance visibility and improve the success rate in such cases. This comprehensive approach improves the accuracy of diagnosis and treatment outcomes in cases with complicated anatomy. [ABSTRACT FROM AUTHOR]

To evaluate the radiographic quality of endodontically treated cases performed by undergraduate dental students at Thumbay dental hospital, Gulf Medical University (GMU) from 2020 to 2022. The sample consisted of 510 randomly selected postoperative periapical radiographs from patient records at the Thumbay dental hospital Gulf Medical University (GMU). Radiographs were from patients who underwent root canal treatment (RCT) performed by 3rd, 4th and 5th year clinical undergraduate dental students. Evaluation criteria included root canal filling (RCF) length, density, taper and the presence of iatrogenic errors. Inter-examiner agreement was measured using a Cohen's kappa test. A comparison of frequency was calculated using the Chi-square test. P-values = 0.05 were considered significant. Adequate length, density, and taper of the root canal fillings was observed in 77.2%, 34%, and 78.6% of cases, respectively. The rate of acceptable quality was higher for teeth treated by 5th -year students (33.3%) compared to those treated by 3rd -year students (20.5%). Density and taper were more adequate in patients treated by 5th -year students (38.6% and 82.1% respectively) compared to 3rd -year student (p= 0.05). Significant differences were observed in procedural errors based on tooth location, with higher percentages in the mandible (23.7%) compared to maxilla. Anterior teeth showed high rates of acceptable quality (36.6%) compared to molars (22.5%). Iatrogenic errors were observed in 19.1% of cases. This study highlights the importance of training dental students to detect and correct procedural errors in root canal procedures at early clinical stage. A notable 29.3% quality improvement achieved with stainless steel K-files, underlines the imperative for enhancing future education approaches to ensure superior results and improved patient care. [ABSTRACT FROM AUTHOR]

To compare the retreatment efficacy of XP-endo Shaper (XPES) and Reciproc Blue (RB) files in in the removal of a bioceramic-based root canal filling material from oval shaped canals. Forty human mandibular first premolars with oval canals were selected for the study. Initially, access cavity preparation and instrumentation were completed. Obturation of the root canals were carried out using a bioceramic sealer (BCS), followed by micro-computed tomography (MCT) analysis to assess the volume of the filling material. The samples were then randomly divided into two groups: Group 1 (XPES) and Group 2 (RB). Post-retreatment procedures (RTP) MCT imaging analysis was conducted, and the volume of the remaining filling material was calculated. Statistical analysis of the data was performed using SPSS software. The mean volume of filling material in both groups did not show statistical significance (p > 0.05). However, XPES demonstrated a significant reduction in the remaining filling material in the C3 and M3 areas (p < 0.05). In contrast, there was no statistically significant difference in the mean volume between the two groups in the A3 area (p > 0.05). XPES is notably more effective than RB in removing root canal filling material from the C3 and M3 areas. [ABSTRACT FROM AUTHOR]

The demand for an ideal obturating material in primary teeth with maximum antibacterial properties keeps escalating to increase the success rate of the root canal treatment in primary teeth. Hence the present study was conducted to determine the antimicrobial efficacy of the different concentrations of a novel obturating material. Different concentrations of the Novel Obturating Material was prepared using Calcium hydroxide, Zinc oxide cement and Metronidazole. It was tested for antimicrobial efficacy against S.mutans and E.faecalis using MHA for 24 hours at 37 ° C. The zone of inhibition was measured in millimetres after 24 hours. The values were subjected to statistical analysis. Maximum zone of inhibition against S.mutans was seen at 100 microliters with statistical significance at 3% 70-30 concentration and no difference was noted against E.faecalis. Comparison in between the groups revealed 1% 70-30 concentration of the Novel Obturating material at 100 microliters showed greater inhibition zone against S.mutans and no difference was noted against E.faecalis. 1% Metronidazole at 70-30 (calcium hydroxide-Zinc oxide) concentration of the Novel Obturating material at 100 microliters is effective against S.mutans and E.faecalis. [ABSTRACT FROM AUTHOR]